Prediction Model for Risk of Hepatocellular Carcinoma After Hepatitis C Viral Eradication

Purpose: The predictors of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C (CHC) and a sustained virologic response after direct-acting antiviral therapy are not well known. Patients and Methods: Between September 2012 and March 2022, this retrospective study enrolled 4426 consecutive patients from 4 hospitals in Taiwan. The patients were divided into derivation (n = 3178) and validation (n = 1248) groups. Results: In the derivation group, age, diabetes mellitus, platelet, albumin, and alpha-fetoprotein at 12 weeks after antiviral therapy were independent predictors of hepatocellular carcinoma. We incorporated these predictors into a novel risk prediction model called the AAAPD-C score ( a ge, a lbumin, a lpha-fetoprotein level, p latelet count, and d iabetes mellitus status), with total risk scores ranging from 0 to 12. The AAAPD-C score had an area under the receiver operating characteristic curve of 0.867 for the validation group at the end of follow-up. The risk score accurately classified patients in both groups into those with low, medium, and high risks. Patients without advanced liver fibrosis with medium-high AAAPD-C risk scores (4– 12) had an annual incidence of HCC > 4 per 1000 person-years. Conclusion: The AAAPD-C score can predict the risk of HCC in patients with chronic hepatitis C and a sustained virologic response after direct-acting antiviral therapy. The tool is accurate and inexpensive, and clinicians can use it to identify patients with chronic hepatitis C at risk of HCC following viral eradication. Plain Language Summary: AAAPD-C score ( a ge, a lbumin, A FP level, p latelet count, and D M status 12 weeks after antiviral therapy) can predict the risk of hepatocellular carcinoma in patients after hepatitis C viral eradication with direct-acting antivirals. It is an accurate, inexpensive, and convenient tool.